NEUROLOGIC MANIFESTATIONS IN CHILDREN WITH LYME-DISEASE

Objective. Lyme disease (LD) is a tickborne spirochetal infection with a wide range of neurologic and non-neurologic manifestations. The cli nical diversity of LD and limitations in serologic diagnosis often mak e it difficult to document the diagnosis of neuroborreliosis with cert ainty. Methods. We reviewed clinical manifestations in 97 seropositive children with particular attention to neurologic manifestations. Diag nostic criteria used in other case surveys were applied to determine h ow often a definitive diagnosis of neuroborreliosis could be made in c hildren. Results. Of 69 children who met criteria for LD, 32% (22) had new neurologic signs, 73% (16) of which were accounted for by facial palsy and aseptic meningitis. Five of those with neurologic findings a lso had erythema migrans (EM), and one had both EM and arthritis. Amon g those with neurologic involvement, boys outnumbered girls two to one . Neurologic abnormalities resolved spontaneously in five children bef ore their serologic results were known. Conclusion. In our series, onl y 27% of children with neurologic abnormalities due to LD had a histor y of EM or arthritis. Seropositivity commonly constituted the primary basis for diagnosis of LD. Despite its nonspecificity, seropositivity for LD in children with neurologic symptoms usually signifies active n euroborreliosis.